Rebuilding front teeth that have worn excessively.
This digital smile makeover gives an example of how dental crowns might be used to rebuild and restore the appearance of worn front teeth, even those that have worn extensively.
We've stipulated the placement of crowns with this case (as opposed to porcelain veneers) because it seems to be an instance where the strength and durability that they offer would be required for long-term success.
Case issues and concerns:
1) In this "before" picture, you can see how this person's front teeth, especially his center two, have worn excessively.
We'd suspect that this is an indication that this person has a deep overbite (meaning that his teeth overlap quite a bit).
This, combined with a tooth-grinding habit (dentists call this activity "bruxism"), could easily result in the appearance we see in this picture.
If we had another photo taken from a different angle, we would probably see that the lower center teeth (the ones directly under the worn upper teeth) have a beveled biting edge.
The idea is that as the lower teeth wear away the uppers (from their backside), the front sides of the lower teeth tend to become more and more beveled.
2) Some of the upper front teeth have white fillings that have deteriorated and stained.
3) In back, on the upper right, this person appears to be missing some back teeth.
Input from site visitors.
Bill
Tue, 01/21/2014 - 19:23
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Teeth needed crowns.
My teeth were pretty similar to this. They were worn from the backside and pretty thin at the biting edge. My dentist said veneers wouldn't work. Had to have crowns placed.
Keith
Fri, 11/03/2017 - 23:41
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Crowns following bruxism
Hi
My upper front teeth are worn and chipped, plus worn to the dentine at the rear due to Bruxism. I have no missing teeth, just fillings and crowns.
I am over 70 and my father is almost 100.
I can supply a picture if needed but the wear is slightly worse than the example on this page, the upper middle teeth being worn more. I always had small teeth.
My dentist advises that I would need crowns on bottom back teeth in order to avoid undue pressure and fracture risk on the top front, if they were crowned. Alternatively he has suggested leaving the current teeth for 10 years, subject to annual review.
I have been wearing a night guard for about 10 years and consciously try to avoid clenching or grinding during the day.
Given the issues that can arrive with crowns I lean to the latter option, but wonder how to weigh up the risks of not doing anything now.
Only 1 of my 4 bottom back teeth appears to be a crown. I wonder too whether only crowning the front teeth with limited extensions would be possible as one of your pages seems to suggest, despite my dentist's above comment.
Can you please advise my best options and their benefits, including any not covered above? A cosmetic improvement would certainly be welcome, but not essential to me.
Staff Dentist
Sat, 11/04/2017 - 12:20
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Keith
We're guessing that due to the amount of wear your teeth have undergone your dentist feels that they need more available space/clearance in order to place upper front crowns.
This would have to do with where your upper and lower front teeth touch. When placing a crown, the tooth needs to be trimmed a certain amount to accommodate its thickness. We would think that your dentist feels that doing so might expose the nerve of your teeth, or else result in tooth nubs so short that the crowns wouldn't stay in place well.
As a solution a dentist will "open the patient's bite." They do this by making the back teeth taller (hence the crowns you mention) so there is more clearance available (front-tooth separation). That way the front teeth don't have to be trimmed so much to accommodate the crowns' thickness.
We get your longevity point. We would also mention that if a person's bruxism is not controlled that placing crowns may offer some benefits short-term but over the long-term will fail and/or cause problems (such as wear) with other teeth.
You seem motivated in your attempts to control your bruxism. And if you were 100% successful the concerns about future wear with or without crowns would be drastically reduced.
You don't mention how successful your efforts seem to have been over the last 10 years. If there are still some issues, have you considered including some daytime use of you guard to further reduce the level of wear that is occurring?
Only you and your dentist can make a decision about your treatment. If aesthetics aren't a big factor and further wear isn't occurring at a great rate, not placing crowns means less expense, less maintenance of restorations (crowns can come off, break, need replacement), usually it's easier to brush and floss natural teeth (thus reducing potential for gum disease), opening a person's bite can cause TMJ problems/issues, crowns that are not polished well can cause extensive wear of opposing teeth with bruxers, when heavy bruxing forces are involved porcelain crowns can break, crown wear can occur in bruxers. Ask your dentist but it seems naive to think that within the next 30 years of your life that this work wouldn't need serious maintenance or outright replacement.
Obviously this isn't an easy choice. Clearly everything depends on the level of bruxing activity that can be expected to continue. Good luck.
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